Possible benefit of regular use of potent mouthwashes in treatment of COVID-19

  

View ORCID ProfileKhalid Mukhtar, Suelen Qassim, Ibn-Masud Danjuma, Mohamed Elhassan Babiker, Mohamed Mohamedali, Housamaddeen Alfarhan, Abdel Rehim El-Tayeh, Mohammed Fakhri Khudhair, Muna Al.Maslamani, Mohammed Al-Dosari, Rumaisa Mohamed Elmustafa, Ahmed Hassib, Wesal Elhadary, Morwan Abdulkarim, Rajvir Singh

doi: https://doi.org/10.1101/2020.11.27.20234997

This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

PDF: https://www.medrxiv.org/content/10.1101/2020.11.27.20234997v1.full.pdf

Abstract

As recently more in vitro studies demonstrated bactericidal and virucidal role for some of the over-the-counter mouthwash solutions. Meanwhile, Game theory and Evolutionary Biology suggests that inhibiting cooperation -reciprocal altruism- between two organisms can negatively affect their survival. Based on a set of relevant publications, it is proposed here that 2019-nCoV may be relying on a complicit; be it a certain organism (e.g. bacterial species), or a state of dysbiosis in general. On this premise, the regular use of potent disinfectant, (Hydrogen peroxide 2% and chlorhexidine gluconate mixed solution) for oral rinsing and gargling three times daily, through the repeated reduction in microbial load, was tested to determine whether it is able to induce a strain sufficient to inhibit reciprocal altruism, and hence halt the progression of the disease. through an RCT, (n = 93, intervention group: 47, control group: 46) the outcome tested in terms of in relation to the PCR/CT test of nasopharyngeal-oropharyngeal swabs from the baseline (at diagnosis), changes in the clinical category (improvement Vs. deterioration), and the final disposition (discharge Vs. Death) in different disease categories. Our findings showed, upon the regular use of mouthwash, more symptoms improvement after 2 days of treatment, higher rate of conversion to COVID19-negative PCR by 5 days of treatment, and less intubation and mortality, with all P-value < 0.05. There was also a trend of improvement in other outcome variables, though with no significant statistical difference; namely shorter hospital stay, less progression in Oxygen requirements, less rate of plasma transfusion, and extent of improvement in terms of disposition in relation to the clinical category on admission. were that can be justified by the complicit hypothesis, predict a rather preventive than therapeutic advantage, suggestive for a possible role for the regular use of potent mouthwash as an additional control measure in the community level.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

ISRCTN10197987 https://doi.org/10.1186/ISRCTN10197987

Funding Statement

The study is funded by Hamad Medical Corporation's Medical Research Center

https://www.medrxiv.org/content/10.1101/2020.11.27.20234997v1

BioNTech slips post-market following BofA downgrade

 

• BioNTech (NASDAQ:BNTX) falls as much as 4.4% after-hours as Bank of America advises investors to cash in profits from the stock's run higher, saying the company now faces heightened competition from peers that also are developing coronavirus vaccines.
• There's limited room for additional gains with the inevitable approval for the COVID-19 vaccine developed with partner Pfizer, which are now reflected in BNTX's 268% YTD rally, BofA analyst Tazeen Ahmad says in downgrading shares to Neutral from Buy with a $126 price target.
• https://seekingalpha.com/news/3640169-biontechminus-2-post-market-following-bofa-downgrade

Powell: 'Challenging' months until vaccine clears production, distribution hurdles

 A slowing recovery and a surging pandemic mean the United States is entering a “challenging” few months, with the potential deployment of a vaccine still facing the hurdles of production and mass distribution before its impact on the economy becomes clear, Fed chair Jerome Powell said on Monday.

“The rise in new COVID-19 cases, both here and abroad, is concerning and could prove challenging for the next few months,” Powell said in remarks prepared for delivery to a congressional hearing on Tuesday morning.

“Recent news on the vaccine front is very positive for the medium term. For now, significant challenges and uncertainties remain, including timing, production and distribution, and efficacy across different groups. It remains difficult to assess the timing and scope of the economic implications of these developments with any degree of confidence.”

Powell’s remarks are his most detailed yet on how the potential arrival of a vaccine may influence the Fed’s outlook, and the evolution of a recovery that the Fed chair acknowledged is slowing.

That, in turn, could shape opinions about how much more government support may be needed to help families and businesses bridge the gap between the current recession and the post-pandemic economy.

Vaccinations could begin before Christmas, U.S. Health Secretary Alex Azar said on Monday. [L1N2IG1LN]

In separate testimony to be delivered at the same hearing, Treasury Secretary Steven Mnuchin said the economy had made “remarkable progress” recovering ground lost due to the pandemic, and that any further government help should be targeted to “workers and small businesses that continue to struggle,” as opposed to spread broadly in the economy.

Mnuchin recently told the Fed to shut down several emergency lending programs, and suggested that $455 billion remaining for those facilities be reallocated for such a program.

With the vaccine on the horizon, some analysts say they expect a strong bounce in the economy in coming months as Americans are inoculated and broad immunity to the coronavirus is achieved.

However, Powell said the fate of the economy will remain hinged to the success of that process, and until then the impact of the pandemic will remain - and fall particularly hard on women, minority groups and those in the service sector.

“A full economic recovery is unlikely until people are confident that it is safe to re-engage in a broad range of activities,” Powell said.

https://www.reuters.com/article/us-usa-fed-powell/powell-challenging-months-until-vaccine-clears-production-distribution-hurdles-idUSKBN28A2ZS

COVID R&D Alliance launches trial of Amgen, UCB, Takeda drugs

 Amgen Inc, UCB SA and Takeda Pharmaceuticals Inc on Monday launched a global trial to identify whether any of three different drugs can reduce the severity of COVID-19 in hospitalized patients by moderating the immune system's response to the disease.

The drugmakers are part of the COVID Research & Development Alliance, a group of more than 20 pharmaceutical and biotechnology companies cooperating to speed development of therapies for the disease that has killed more than 1.4 million people worldwide.

The study initially will test whether Amgen’s psoriasis drug Otezla, Takeda’s experimental anti-inflammatory lanadelumab, and UCB's experimental immune system-inhibitor zilucoplan can prevent the body's own defenses from overreacting to the coronavirus, which can lead to serious, sometimes fatal, tissue and organ damage.

The three compounds "have a plausible biologic rationale in terms of effect on immune response or the hyper-immune response that some people develop," said Amgen research chief David Reese.

"We hope to find options that could potentially save lives ... before widespread availability of a vaccine,” he said.

Health experts do not expect vaccines to be available to most people until well into 2021. Meanwhile, COVID-19 hospitalizations are at record levels in the United States, threatening to overwhelm health systems.

The multiple candidates will be tested against a placebo with all trial patients also receiving standard care. Other drugs that work in a variety of ways, including antivirals, medicines that also modulate immune response and vascular agents may enter the study in coming months.

So far, only a generic class of steroids used since the 1960s to reduce inflammation in diseases such as arthritis has been shown in a controlled study to improve survival for severely ill hospitalized COVID-19 patients. Steroids are not recommended for patients with less severe illness.

The COVID R&D trial will enroll both hospitalized intensive care unit and non-ICU patients.

In anticipation of a rise and fall of COVID-19 cases in various geographic regions, the trial will include sites in the United States, Brazil, Mexico, Russia, South Africa and other countries.

“COVID is not confined to one country ... We have included a broad range of different countries," said Dhavalkumar Patel, UCB's chief scientific officer. 

https://www.marketscreener.com/quote/stock/AMGEN-INC-4847/news/COVID-R-D-Alliance-launches-trial-of-Amgen-UCB-Takeda-drugs-31903555/

Here’s when vaccines will trigger global growth next year, says Goldman Sachs

 The world's advanced economies expect a vaccine to drop by mid December – that should also mean the start of the road to economic recovery in 2021, according to Goldman Sachs analysts.

Considering the data around immunisation timelines, some of which is uncertain, the analysts expect "widespread immunisation should drive a sharp pickup in global growth starting in Q2."

Analysts Daan Struyven and Sid Bhushan examined vaccine-related data to forecast the speed and challenges that large advanced economies – the UK, US, Canada, Japan, Australia and the European Union – might face when rolling out a vaccination programme. Their analysis considered global vaccine production, country vaccine supply, vaccine distribution capacity and country monthly vaccinations.

For both the US and Canada, vaccinations are expected to be initially scarce but supply should exceed demand by April.

The analysts say the UK is expected to vaccinate 50% of its population in March with the US and Canada following in April. They forecast that the EU, Japan, and Australia would reach this 50% threshold in May.

The US investment bank’s economic research, “Vaccinating the Population: A Timeline”, comes as doubts have surfaced surrounding one of the main vaccine candidates. The Oxford-AstraZeneca Covid-19 vaccine, which had announced on 23 November that under one of its dosing regimens it has a 90% efficacy rate, has faced heightened scrutiny after revelations that the half dose given during trials was a result of errors as well as the age groups of volunteers.

The UK government has asked the regulator, the Medicines and Healthcare products Regulatory Agency, to assess the vaccine for approval.

“The medium-run effects of the various vaccine candidates, their impact on transmission, vaccine supply, and especially vaccine demand remain quite uncertain and imply that risks are skewed to a later timeline,” the analysts noted in their November 26 note.

If two of the vaccines – AstraZenenca and Johnson & Johnson’s – do not succeed, vaccinations will be slower in Europe, a region that relies more on these developers, the analysts said.

https://www.fnlondon.com/articles/heres-when-vaccines-will-trigger-global-growth-next-year-says-goldman-sachs-20201130

Saving Lives of COVID-19 Patients by Using Existing Treatment Earlier

 The lives of patients hospitalized with COVID-19 are being saved by doctors who are using an existing medical treatment at an earlier stage.

Dr. Luigi Sedda of Lancaster University analyzed the results from the team at Wrightington, Wigan and Leigh Teaching Hospitals NHS Trust (WWL). Their research has now been published in the prestigious medical journal BMJ Respiratory Open.

He said: “We show that Continuous Positive Airway Pressure (CPAP) in the first days of hospitalization seems to save between 10% to 20% of patients. However, it is important to underline that this was a pilot study with a small sample size, although comforting evidence is starting to emerge elsewhere.”

According to NHS England, 96% of people who died with Covid had at least one serious health condition and the majority are over the age of 80.

The team led by Dr. Abdul Ashish used the CPAP machines on patients with COVID-19 admitted to the Royal Albert Edward Infirmary in Wigan.

In the case of patients with severe acute respiratory syndrome, COVID-19 may cause the lungs to swell and collapse. Using CPAP treatment, which is often used at home to help people with sleep problems, helps to keep the lungs open and makes breathing easier.

The research conducted by the team showed how CPAP treatment can be delivered effectively in a ward setting, with low resources both across the country and worldwide where intensive care bed availability is limited.

The research has so far helped almost a hundred patients at the Royal Albert Edward Infirmary.

Consultant Respiratory Physician Dr. Ashish said: “When you use CPAP early in the admission it stops the patient getting worse, therefore avoiding invasive ventilation techniques. As CPAP is readily available and can be used in a ward setting, we have demonstrated that, when used early, it can be very effective way of treating severe COVID-19 pneumonia.

“We are one of the early adopters of ward based CPAP in the North West and have developed local protocols and pathways by modifying our existing CPAP machines to deliver good outcomes for our patients.”

The researchers also found that the early use of CPAP potentially reduces lung damage during the worst of the COVID-19 infection and allows the patient to recover from the inflammatory effects. However, when used later, CPCP does not prevent lung damage thus leading to additional inflammation and a reduction in survival chances.

Dr. Martin Farrier, Associate Medical Director, said: “”We are at the forefront of developing care for COVID-19 patients and have developed a very effective treatment strategy for our population who develop lung failure following COVID-19 infection. The people of Wigan can be sure that they are going to get the best care at WWL because we have helped to develop the best care.”

He praised Dr. Luigi Sedda and his team at Lancaster University.

“This collaboration with Lancaster University has been remarkable and allowed us to deliver high quality research.

“The BMJ Respiratory Open is a very significant journal, but more than that, the results of the work are important in terms of our response to COVID-19 and for our organization. This is the most important publication on the use of CPAP in treating COVID-19 patients and shows a significant association with a fall in mortality. The way that we treat patients here in Wigan has been influential in the way that patients are now treated in other organizations.”

Reference: “CPAP management of COVID-19 respiratory failure: a first quantitative analysis from an inpatient service evaluation” by Abdul Ashish, Alison Unsworth, Jane Martindale, Ram Sundar, Kanishka Kavuri, Luigi Sedda and Martin Farrier, 4 November 2020, BMJ Open Respiratory Research.
DOI: 10.1136/bmjresp-2020-000692

https://scitechdaily.com/doctors-save-the-lives-of-covid-19-patients-by-using-existing-treatment-earlier/

Up to 30% in US may be infected with coronavirus by year-end: Gottlieb

 Dr. Scott Gottlieb told CNBC on Monday that nearly one-third of U.S. residents could ultimately be infected by the coronavirus at the end of 2020.

The significant level of prior infections is likely to have implications for transmission of the virus in 2021, when there is the potential for Covid-19 vaccines to be deployed across the country, according to the former Food and Drug Administration commissioner.

“We’re going to probably have by the end of this year, 30% of the U.S. population infected,” Gottlieb said on “Squawk Box.” The country has roughly 330 million people. “You look at states like North Dakota and South Dakota, it’s probably 30%, 35%. Maybe as high as 50%,” he added.

There are roughly 13.4 million confirmed coronavirus infections in America so far this year, according to data compiled by Johns Hopkins University. New daily U.S. cases recently reached single-day records around 200,000.

However, Gottlieb has stressed throughout the pandemic that the actual number of infections is likely higher than that because not everyone who contracts the virus is tested and ultimately diagnosed. In early November, for example, when the country’s daily cases were around 121,000, Gottlieb suggested the actual case number was much higher.

“We’re probably, at best, diagnosing 1 in 5 cases right now, maybe a little bit less than that, so this is at least half a million cases a day, probably more in terms of actual numbers of infection,” Gottlieb said Nov. 6.

The nation’s Covid-19 outbreak has intensified since those remarks. The U.S. seven-day average of new coronavirus cases is nearly 162,400, according to a CNBC analysis of Johns Hopkins data. While that’s down almost 5% compared with a week ago, inconsistent data reporting due to the Thanksgiving holiday makes the numbers challenging to interpret.

Nonetheless, Gottlieb said the scale of the coronavirus outbreak over the course of 2020 could help limit the spread of the virus early next year if vaccinations begin. Gottlieb is a board member of Pfizer, which was the first company to apply for emergency use authorization with the FDA for its Covid-19 vaccine. His remarks came before Moderna announced its intentions to apply for the same authorization Monday after it announced new data that confirmed its vaccine was more than 94% effective and safe.

“You combine a lot of infection around the country with vaccinating 20% of the population [and] you’re getting to levels where this virus is not going to circulate as readily, once you get to those levels of prior immunity,” Gottlieb said.

To get to so-called heard immunity, however, health experts estimate between 60% to 80% of a population must be vaccinated or have natural antibodies, allowing them to fight off the virus and significantly curtail its spread in a population. 

Earlier this month, Gottlieb urged Americans to take seriously coronavirus precautions around the holiday season, saying the country was facing “really one last surge of infection” and “I do believe 2021 is going to be better.” He added, “We have to get through the next two or three months, and so this is going to be, really, a temporary pain.”

https://www.cnbc.com/2020/11/30/dr-scott-gottlieb-30percent-of-us-may-get-covid-19-by-year-end.html